DIOCESE OF PITTSBURGH VOLUNTEER REQUEST FOR WAIVER OF FBI – FEDERAL CRIMINAL HISTORY FINGERPRINT RECORD CHECK Required by the Child Protective Service Law 23 Pa. C.S. Section 6344.2 (relating to volunteers having contact with children) I swear/affirm that I am seeking a volunteer position and AM NOT required to obtain a clearance through the Federal Bureau of Investigation, as: • the position I am applying for is unpaid; and • I have been a resident of Pennsylvania during the entirety of the previous ten-year period. I swear/affirm that I have NEVER been named as a perpetrator of a founded report of child abuse within the past five (5) years as defined by the Child Protective Services Law. I swear/affirm that I have NEVER been convicted of any of the following crimes under Title 18 of the Pennsylvania consolidated statues or of offenses similar in nature to those crimes under the laws or former laws of the United States or one of its territories or possessions, another state, the District of Columbia, the Commonwealth of Puerto Rico or a foreign nation, or under a former law of this Commonwealth. Chapter 25 (relating to criminal homicide) Section 2702 (relating to aggravated assault) Section 2709 (relating to stalking) Section 2901 (relating to kidnapping) Section 2902 (relating to unlawful restraint) Section 3121 (relating to rape) Section 3122.1 (relating to statutory sexual assault) Section 3123 (relating to involuntary deviate sexual intercourse) Section 3124.1 (relating to sexual assault) Section 3125 (relating to aggravated indecent assault) Section 3126 (relating to indecent assault) Section 3127 (relating to indecent exposure) Section 4302 (relating to incest) Section 4303 (relating to concealing death of child) Section 4304 (relating to endangering welfare of children) Section 4305 (relating to dealing in infant children) Section 5902(b) (relating to prostitution and related offenses) Section 5903(c) (d) (relating to obscene and other sexual material and performances) Section 6301 (relating to corruption of minors) Section 6312 (relating to sexual abuse of children), or an equivalent crime under Federal law or the law of another state. I have not been convicted of a felony offense under Act 64-1972 (relating to the controlled substance, drug device and cosmetic act) committed within the past five years.
I understand that I shall not be approved for service if I am named as a perpetrator of a founded report of child abuse or have been convicted of any of the crimes listed above or of offenses similar in nature to those crimes under the laws or former laws of the United States or one of its territories or possessions, another state, the District of Columbia, the Commonwealth of Puerto Rico or a foreign nation, or under a former law of this Commonwealth. I understand that if I am arrested for or convicted of an offense that would constitute grounds for denying participation in a program, activity or service under the Child Protective Services Law as listed above, or am named as perpetrator in a founded or indicated report, I must provide the administrator or designee with written notice not later than 72 hours after the arrest, conviction or notification that I have been listed as a perpetrator in the Statewide database. I understand that if I willfully fail to disclose information required above, I commit a misdemeanor of the third degree and shall be subject to discipline up to and including denial of a volunteer position. I understand that the person responsible for employment decisions or the administrator of a program, activity or service is required to maintain a copy of my clearances. I hereby swear/affirm that the information as set forth above is true and correct. I understand that false swearing is a misdemeanor pursuant to Section 4903 of the Crimes Code.
I understand that I shall not be approved for service if I am named as a perpetrator of a founded. report of child abuse or have been convicted of any of the crimes ...
Phone urber 72.935.835. Email address: largeabirdcorncast.net .... with business or professional experience as set forth in Appendix G. All employees of Jefferson. Academy will be employed on an at-will ... Replacement Plan: Jefferson Academy will hi
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Page 1 of 60. Bohol Profile. Bohol. Basic Facts. Geographic Location Bohol is nestled securely at the heart of the Central. Visayas Region, between southeast of Cebu and southwest. of Leyte. Located centrally in the Philippine Archipelago, specifical
In consideration of having been accepted as a volunteer for the above-referenced department of Gwinnett County, and with the knowledge that I will be working, directly or indirectly, in a volunteer capacity for Gwinnett County involving various dutie
Name of Participant ... I also understand and acknowledge that the social and economic losses or damages ... and MAC officers, directors, agents and employees, from all liability to me and to my conservators, guardians or other legal ...
Sep 3, 2013 - Synopsis: Enhancing Mobile Populations' Access to HIV and AIDS Services, Information and. Support a 5 year project funded by Big Lottery ...
Feb 26, 2015 - In the event taxes are imposed on the services purchased, the District will not be responsible for payment of the taxes. The vendor shall absorb the taxes entirely. Upon request, the District's Tax Exempt Certificate will be furnished.
... AND WAIVER OF LIABILITY. Name of Participant ... with event registration # (______) herein referred to as ''the program'' made available through the ...
Feb 26, 2015 - We are currently reducing the number of small printers in our inventory, so any proposal must be able to adjust based on future changes in printer inventory. The AOS92 computing environment consists of approximately 2,000 devices inclu
STATUS: (circle one) Corporation Sole Proprietor Partnership Other. CONTACT NAME: ADDRESS: CITY: ST. ZIP. PHONE NUMBER: FAX: EMAIL ADDRESS: HOLD HARMLESS CLAUSE: The Christmas Parade Entrant listed above hereby agrees to indemnify and hold harmless t
Support a 5 year project funded by Big Lottery Fund, UK, is seeking a consultant / organization to produce a video documentary on role of EMPHASIS in ...
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In consideration of the opportunity to participate in the Gladiator Rock'n Run (the. âEventâ), the ... and natural obstacles, broken bones, drowning, weather conditions (extreme heat, cold,. humidity, etc.) ... upon the written request of any par
Synopsis: Enhancing Mobile Populations' Access to HIV and AIDS Services, Information ... Proven experience in making documentaries on development issues.
Legal owner will be responsible for recycling container(s). If lost or stolen, responsible party will be billed for them on the next Sanitation billing @$35.00 per ...
Nov 20, 2015 - Trade secrets and other proprietary data contained in proposals may be ..... The Town shall provide the bidder a reasonably secured storage space for .... Any bid containing a corporate bidder's certification to the statement of ...
Phone: 215 249-3310 Fax: 215 249-9875. DUBLINBOROUGH.ORG. Please mail to the above address or drop off at the Borough Hall. APPLICANT INFORMATION. Name: Home Address: Home Telephone Number: Cell Phone Number: Number of years residing in Dublin Boroug
